The Disease Slush Fund

This week, House appropriators introduced legislation which would increase NIH funding to $33.3 billion, which is $1.3 billion more than this year’s funding. It would also set aside $390 million for the federal Zika response. STAT’s Dylan Scott has the full story.

This bill comes as an alternative to the emergency funding fight that’s sprawled across the last few months. Republicans have argued that funding for disease relief should come about through the normal appropriations process.

The emergency funding fight, currently on hold for a Congressional recess, started with the Obama administration’s request for $1.9 billion for Zika relief. Since then, proposals and counterproposals have ping-ponged back and forth between houses of the legislature, with the administration drawing on leftover Ebola money to fund the Zika fight. The Senate approved $1.1 billion in funding in May; House Republicans offered $622 million. Senate Democrats blocked a compromise bill for $1.1 billion—$750 million of which was drawn from cuts to other government expenditures—on June 28th. Democrats cited measures inserted by Republicans to cut Affordable Care Act funding (and the removal of a provision to ban flying of Confederate flags at federal cemeteries).

Back in April, FiveThirtyEight’s Maggie Koerth-Baker compared the emergency Zika funding battle to a slush fund for infectious disease. It’s an apt comparison, especially as the Obama administration, absent Congressional financial assistance, drained funds originally appropriated for Ebola to fight Zika, only the latest infectious disease in a time when global infectious disease outbreaks (and varieties) are on the rise. The United States has certainly established itself as a global force in combatting epidemics, providing financial and military assistance in the West Africa Ebola outbreak. The Zika funding fight though, has been particularly brutal. It’s easy to cry government dysfunction and partisanship, and there’s certainly plenty to go around, but there’s another more perverse relationship at play, too. At the end of the day, infectious disease outbreaks just don’t align with legislative cycles. Epidemiological response requires forecasting, detective work, and some guessing. Government agencies might be funded by the fiscal year, but there’s no telling what the CDC, NIH, and others will have to fight next, not how big that fight will be. The best case scenario, perhaps, is influenza, which utilizes half a year of careful surveillance to identify dominant strains and manufacture vaccines before Northern-Hemisphere flu season arrives. Zika and Ebola though, can emerge rapidly, producing calls for help overnight.

Consider the controversy and outrage over the public health response to Flint, Michigan’s lead crisis, a situation that arose more of less entirely because of policy. Now consider an enemy that follows no human schedules. Whether funding arrives in the form of an emergency bill or the regular appropriations process, infectious disease relief in its current form will always see that now-familiar fight over just how much is needed, and how badly. Disease will stay partisan for as long as we allow it to.